Lynda and “Abyle” products

Blood pump Moves blood in all the therapies. In CRRT the blood flow is between 0.30 and 450 ml/min. In CRRT the blood flow is between 0.30 and 450 ml/min. In CPFA and PEX the blood flow ranges from 0.30 to 250 ml/min. In CPFA and PEX the blood flow ranges from 0.30 to 250 ml/min.

Ultrafiltration Pump Moves the ultrafiltration fluid, ranging from 0.5 to 12 lt/h. Variable- Wanted weight loss Reached weight loss

Plasma Pump It moves Pre-dilution infusion, range Lt/h, in CVVH/ IHF and Post-dilution infusion, range Lt/h, in CVVHD/CVVHDF/IHD/IHDF. In CPFA the plasma flows in a range from 0.5 to 25 % of blood’s flow

Infusion Pump In CVVH/ IHF/ CPFA - moves post-dilution infusion. In CVVHD/ CVVHDF/ IHD/ IHDF - moves dialysate. In PEX - moves substitution fluid. Flow ranges from 0-12 Lt/h Allows control over the precent of pre to post dilution infusion (green to blue pump flow).

Citrate pump This pump delivers citrate into the blood line.

7 Pressure Transducers 7 pressure transducers check different pressures: arterial - from to +30 mmHg venous - from -30 to +300 mmHg prefilter - from 0 to +400 mmHg transmembrane (TMP) - from -300 to +400 mmHg plasma output cartridge output cartridge input

Blood Leak Detector Optic detector with 2 sensors, can show a blood leak on the filtrate line.

Air detector and clamp An ultrasonic sensor reports the presence of air bubbles if bigger than 50 µl. This sensor is connected with a clamp to stop the venous blood flow in case of alarm.

Syringe Pump A pump for administration of continuous (0-10 ml/h) or bolus (0-20 ml) of anticoagulant or Ca 2+. The pump can accept syringes of all types with a variable volume between 20 to 60 ml.

HCT and SO 2 Meter The Hematocrit (with blood volume calculation) and the Saturation are measured continuously through a high-precision instrument from the arterial line. There is also the possibility of checking the hemo-concentration through the direct measure of HCT.

Infusion Scale It controls the infusion- dialysate fluid. It can hold up to 40 liters exchange.

Ultrafiltration Scale It controls the ultrafiltrate fluid. It can hold up to 40 liters exchange.

Heater It allows to heat the infusion fluid in pre or post dilution. The temperature can be set between 30 ° C and 40 ° C with steps of 0.1 ° C.

Display touch screen A high-visibility display with user friendly and intuitive touch-screen interface. Allows clear, fast and direct dialogue with the machine. It shows colors and a clear graphic line with its 10.5 inches.

Display The screen is divided into 4 areas in which information appear. Title area : name of active window and treatment. Active window : displays information and allows the user to set all data. On line guide Function keys : they are used to activate different functions.

Placement Kit disposable

SCUF (SLOW CONTINUOUS ULTRAFILTRATION) Uf EMOFILTRO

CVVH, IHF-HVHF (CONTINUOUS VENO-VENOUS HEMOFILTRATION/ INTERMITTENT HEMO FILTRATION – HIGH VOLUME HEMOFILTRATION) Uf

CVVHD/ IHD-SLED (CONTINUOUS VENO-VENOUS HEMODIALYSIS / INTERMITTENT HEMODIALYSIS SLOW EXTENDED DIALYSIS) Uf

CVVHDF/ IHDF ( CONTINUOUS VENO-VENOUS HEMODIAFILTRATION / INTERMITTENT HEMODIAFILTRATION) (CONTINUOUS VENO-VENOUS HEMODIAFILTRATION / INTERMITTENT HEMODIAFILTRATION) Uf

PEX (PLASMA EXCHANGE) Liquido di sostituzione Post diluizione Plasma PLASMAFILTRO Thanks to a laminar flow, formed elements of blood are repelled by the electronegative membrane. Thus the activation and / or platelet dispersion is much more limited and erythrocytes survival is significantly unaffected.

CPFA (COUPLED PLASMA FILTRATION ADSORPTION) anticoagulante

TissuePlasma Red blood cell Capillary wall CO 2 O2O2 O2O2 HCO 3 - Cl - Na + H2OH2O CO 2 + H 2 O ca H 2 CO 3 HCO 3 - H + K+K+ H2OH2O O2O2 } Hb } HHb HbO 2 CO 2 O2O2 3-5% 85-90% 7-10% CO 2 Cl -

Alveolar wall CO 2 O2O2 O2O2 HCO 3 - Cl - Na + H2OH2O CO 2 CO 2 + H 2 O ca H 2 CO 3 HCO 3 - H + K+K+ H2OH2O O2O2 } Hb } HHb HbO 2 CO 2 O2O2 Cl - CO 2 LungPlasma Red blood cell

VAP – Ventilator associated pneumonia Barotrauma – Pneomothorax Volutrauma - Overdistention induced permeability edema Atelectrauma - Shear injury induced by repeated airway opening/closing Biotrauma - Inflamatory reaction in the lung

Dreyfuss et al. Am Rev Resp Dis 1985, 132:

Tremblay et al. J Clin Invest 1997, 99: MV- Moderate Volume HV- High Volume HP- High PEEP ZP- Zero PEEP

Tidal Volume (TV) Frequency (F) % O 2 (FIO 2 ) Pressure (P) A “protective” technique (low TV) for avoiding VILI causes exceeding CO 2 levels that should be removed to avoid Acidosis.

(Veno-venous) ECCO 2 R (Venovenous Extracorporeal CO 2 Removal) CO2

ECMOCPB Duration Up to 4 days ECMO Vs CPB 21 daysSeveral hours

1. Does ECCO 2 R oxygenate the blood? Answer: Yes, but not enough to oxygenate the patient. 2. How long is the treatment? Answer: A single kit can be used for up to 4 days, after 48 hours replacing the tubing (not the oxygenator) is needed! 3. Can we perform ECCO 2 R and CRRT at the same time? Answer: Bellco is still working on it. PO 2 8mm/HgPO 2 650mm/Hg ECCO 2 R: ECMO:6000 ml/min 450 ml/min

 Lilliput ECMO2 Oxygenator  Polymethylpentene membrane  Membrane surface 0,67 m 2  Heater surface 0,02 m 2  Filling volume 90 ml  Connections 1/4”- 5/16”  Maximum flow 450 ml/min  4 days duration  ETO Sterilization

Non thrombogenic surfaces: PHISIO COATING COATINGCOATING

Polypropylene “standard“ membrane Polymethylpentene “plasma-tight“ membrane gas comes into contact with blood through microporous fibres. gas transfer is obtained through direct contact. The hollow fibres are protected by an external thin membrane. Gas transfer is obtained by diffusion. Plasma-tight membrane: POLYMETHYLPENTENE

(Citrate)

Continuous Treatments for Renal Failure Intermittent Treatments for Renal Failure Therapeutic Plasma Exchange Treatments CPFA Treatment for patients with severe sepsis, septic shock or MOF Treatment for CO 2 Removal